28th Case of the Week Due 9/6/19, by 1pm EST

Emblem Commercial LTAC, Reviewed 8/16/19.

CCR4. 65 yo, Admitting Dx 6/10/19: Septic, intubated-traumatic intubation, dev Pneumomediastinum/Subc Emphysema, cardiac arrest improved rapidly. Extubated, later dev rt sided PTX S/p chest tube insertion. Steroids, insulin & broad-spectrum ABX septic shock & presumed HCAP. CT Chest/Neck: Esophageal perforation & persistent Pneumomediastinum. Drain placed removed "creamy colored fluid." Resp cultures +pseudomonas, required Pressor support for septic shock, started on Linezolid/Micafungin/Meropenem. Intubated. Upper Endoscopy, Esophagoduodenoscopy/Stent placement 6/20/19. Post-op 2U PRBC POD1, remained intubated until POD 2, now tolerating NC. Re-intubation s/p RT Thoracotomy w/ thoracic washout & decortication & chest tube placed 6/24/19. S/p Intercostal Nerve Block 7/24/19. Upper GI Study, Esophageal leak; managed conservatively; stable. Physical Findings:HGB 8.2m HCT 27.4, Crea 1.78, BUN 89. Expected DCP:Cont comfort measure. Expected DC date: Eval weekly. Physical Findings: Heart: S1, S2 positive, regular. Lungs: Bilat BS; Rt chest tube. PMH:HTN, Obesity, Asthma, Multiple Intubations. PLOF/ Living Situation:Not provided. Home Setup:Not provided. Behavioral Health:Cooperative. Advanced Directive/Living Will:Full code; family wants aggressive intervention. Service requested for: LTAC. *Skilled Medical Needs:IV ABT, Rt chest tube-monitor drainage; monitor Labs and IV/PO Med changes as needed. Ventilator Information:N/A. Meds & IV fluids To Be Continued in LTAC:Cefepine 1 gram q 12 hrs Infection. Rt chest tube/ D10 1L q 24hours. Clonidine HTN. Tramadol PRN pain. Albuterol SOB. VS/LABS: 126/75, 98.1, pulse 101. Wounds: Not provided. Nutrition: 8/14 TPN w/Lytes. Mostly confined in bed. Progress being made, stable.*Current Mental Status: AAOX3. Dementia Score: N/A. All Functional Skills Not Tested and Unchanged.


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